Chapter 10

The Head and Neck

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Anatomy and Physiology
v Contains the following structures:
o Cranium
o Face
o Sensory organs
o Neck
o Thyroid gland
o Lymph nodes

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Anatomy and Physiology
The Head #1

v Regions take name from underlying bones of skull

o Frontal
o Parietal
o Temporal
o Occipital

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Anatomy and Physiology
The Head #2

Copyright © 2018 Wolters Kluwer · All Rights Reserved

The Health History
The Head #1
v Common or concerning symptoms
o Headache
o Head injury
o Head or neck surgery
o Traumatic brain injury

Copyright © 2018 Wolters Kluwer · All Rights Reserved

The Health History
The Head #2
v Headache
o Most common complaint
o Tension headache most common but usually self-
treated
o Migraine headaches most frequent
o Need to rule out life-threatening causes
§ Meningitis
§ Subdural or intracranial hemorrhage
§ Tumor

Copyright © 2018 Wolters Kluwer · All Rights Reserved

The Health History
The Head #3
v Headaches (cont.)
o Primary
§ No identifiable underlying cause
§ Bilateral
§ Steady, pressing or tightening, nonthrobbing, mild
to moderate intensity

Copyright © 2018 Wolters Kluwer · All Rights Reserved

The Health History
The Head #4
v Headaches (cont.)
o Secondary
§ Arises from other conditions
§ Rule out other conditions first
§ Look for “red flags”

Copyright © 2018 Wolters Kluwer · All Rights Reserved

The Health History
The Head #5
v Headaches (cont.)
o “Red flags”
§ Recent onset
§ Acute onset like “thunderclap”
§ Markedly elevated blood pressure
§ Presence of rash or signs of infection
§ Presence of cancer, HIV, or pregnancy
§ Vomiting (projectile)
§ Recent head trauma

Copyright © 2018 Wolters Kluwer · All Rights Reserved

The Health History
The Head #6
v Migraine headaches
o Episodic
o Tend to peak over several hours
o Unilateral
o Prodromal onset and/or aura
o Nausea and vomiting
o Positive family history

Copyright © 2018 Wolters Kluwer · All Rights Reserved

The Health History
The Head #7
v Tension headaches
o Episodic
o Tend to peak after several hours
o Often arise in temporal area
o Consider medication overuse

Copyright © 2018 Wolters Kluwer · All Rights Reserved

The Health History
The Head #8
v New, persisting, progressively severe headache
o Raise concerns of tumor, abscess, or mass
o If sudden and severe, consider subarachnoid
hemorrhage related to head injury, meningitis, or
stroke.
o Nausea and vomiting
o Increased pain with coughing, sneezing, or changing
position

Copyright © 2018 Wolters Kluwer · All Rights Reserved

The Health History
The Head #9
v Cluster headaches
o Retro-orbital
o Unilateral

(Refer to Table 10-1, Primary Headaches)

(Refer to Table 10-2, Secondary Headaches)

Copyright © 2018 Wolters Kluwer · All Rights Reserved

The Health History
The Head #10
v OLD CART questions
o Onset: When did you notice the headache?
o Location: Where do you feel the headache? Can you
point to the area(s)?
o Duration: How long has this been going on? Begin
suddenly or gradually? Temporary or constant? How
long does it last?
o Characteristic symptoms: What does it feel like?
Describe the pain using scale of 1 to 10

Copyright © 2018 Wolters Kluwer · All Rights Reserved

The Health History
The Head #11
v OLD CART questions (cont.)
o Associated manifestation: Do you notice any other
symptoms? What happened just before the
headache? Any history of overuse of analgesics,
ergotamine or triptans?
o Relieving factors: What have you tried to make the
headache go away? What has worked the best?
o Treatment: Has anyone treated you for headaches
over the past year? What type of headache was
diagnosed? Have you used any medication?

Copyright © 2018 Wolters Kluwer · All Rights Reserved

The Health History
The Head #12
v Traumatic brain injury
o Blow to head or piercing head injury that interferes
with brain function
o Not all injuries to head result in brain injury.
o May be mild to severe
o May be time lapse between injury and manifestation
of symptoms

Copyright © 2018 Wolters Kluwer · All Rights Reserved

The Health History
The Head #13
v Traumatic brain injury—OLD CART questions
o Onset: When did this occur? Do you remember how
you hurt your head?
o Location: Can you show me where it hurts?
o Duration: Did you lose consciousness? For how long?
o Characteristic Symptoms: Did you experience
symptoms prior to the head injury?

Copyright © 2018 Wolters Kluwer · All Rights Reserved

The Health History
The Head #14
v Traumatic brain injury—OLD CART questions
o Associated manifestations: Do you experience vision
changes, nausea or vomiting, attention span deficits,
dizziness, confusion, drainage from the ears, nose,
eyes, or mouth; tremors, seizures, or gait changes?
o Relieving factors/strategies: prevent further injury

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Question #1
v Athletes involved in contact sports should be evaluated
for _________ if a suspected head injury has occurred.
A. Concussion
B. Vision difficulties
C. Nausea and vomiting

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Answer to Question #1
v Athletes involved in contact sports should be evaluated
for _________ if a suspected head injury has occurred.
v A. Concussion
v Any athlete that has a suspected head injury should be
evaluated for a concussion. Blurred vision and nausea
and vomiting are possible signs of a traumatic brain
injury.

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Anatomy and Physiology
The Neck #1

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Anatomy and Physiology
The Neck #2

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Anatomy and Physiology
The Neck #3

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Anatomy and Physiology
The Neck #4

Copyright © 2018 Wolters Kluwer · All Rights Reserved

The Health History
The Neck #1
v Common or concerning symptoms
o Swollen lymph nodes or neck lumps
o Enlarged thyroid gland
o Hoarseness

Copyright © 2018 Wolters Kluwer · All Rights Reserved

The Health History
The Neck #2
v Enlarged lymph nodes
o Commonly accompany pharyngitis
v Goiter (enlarge thyroid gland)
o Thyroid function may be increased, decreased, or
normal.
o Temperature intolerance
§ Too cold: suggests hypothyroidism
§ Too hot: suggests hyperthyroidism

Copyright © 2018 Wolters Kluwer · All Rights Reserved

The Health History
The Neck #3
Hyperthyroidism Hypothyroidism
Symptoms Nervousness Fatigue, lethargy
Weight loss Modest weight gain with
anorexia
Excessive sweating, heat Dry, coarse skin, cold
intolerance intolerance
Palpitations Swelling face, hands, legs
Frequent bowel Constipation
movements
Proximal muscular Weakness, muscle cramps,
weakness and tremor arthralgias, paresthesias,
impaired memory and hearing

Copyright © 2018 Wolters Kluwer · All Rights Reserved

The Health History
The Neck #4

Hyperthyroidism Hypothyroidism
Signs Warm, smooth moist skin Dry, coarse, cool skin,
yellowish, nonpitting edema,
loss of hair
Staring, lid tag, Periorbital puffiness
exophthalmos
increased systolic, Decreased systolic and
decreased diastolic BP increased diastolic BP
Tachycardia or atrial Bradycardia and hypothermia
fibrillation
Hyperdynamic cardiac Intensity of heart sounds
pulsations
Tremor and proximal muscle Impaired memory, mixed
weakness hearing loss, somnolence

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Question #2
v Which of the following symptoms is not characteristic of
hypothyroidism?
A. Hoarseness
B. Intolerance to cold
C. Palpitations
D. Constipation

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Answer to Question #2
v Which of the following symptoms is not characteristic of
hypothyroidism?
v C. Palpitations
v Hoarseness, intolerance to cold, and constipation are
commonly seen with hypothyroidism. Palpitations may be
seen with hyperthyroidism.

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Physical Examination #1
v Equipment needed
o Tangential light
o Cup of water
o Stethoscope
v Remember cultural views when examining.
v Ask patient to remove items from hair.

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Physical Examination #2
v Hair
o Note quantity, distribution, texture, and pattern of
loss.
§ Fine hair: hyperthyroidism
§ Coarse hair: hypothyroidism
o Nits: tiny white ovoid granules (eggs of lice)

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Physical Examination #3
v Scalp
o Scaliness, lumps, nevi, other lesions
o Redness or scaling: seborrheic dermatitis, psoriasis
o Soft lumps: pilar cysts or pigmented nevi

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Physical Examination #4
v Skull
o General size and contour
§ Macrocephaly
§ Microcephaly
o Deformities, depressions, lumps, tenderness
o Learn to recognize irregularities
§ Suture lines

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Physical Examination #5
v Face
o Facial expression
o Contours
o Asymmetry
o Involuntary movements
o Edema
o Masses

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Physical Examination
The Face #1

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Physical Examination
The Face #2

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Physical Examination
The Face #3

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Physical Examination
The Skin
v Observe
o Color
o Pigmentation
o Texture
o Thickness
o Hair distribution
v Acne
v Hirsutism

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Physical Examination
The Neck
v Skin
v Symmetry
v Masses or scars
v Enlargement of glands
v Any visible lymph nodes

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Physical Examination
The Lymph Nodes #1

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Physical Examination
The Lymph Nodes #2

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Physical Examination
The Lymph Nodes #3

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Physical Examination
The Trachea and Thyroid #1
v Inspect trachea for any deviation.
v Feel for any deviation.
v Spaces should be symmetric.
v Inspect the region below cricoid cartilage for thyroid.
v Ask patient to sip water and swallow; watch for thyroid
movement.

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Physical Examination
The Trachea and Thyroid #2

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Physical Examination
The Trachea and Thyroid #3

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Physical Examination
The Trachea and Thyroid #4

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Physical Examination
The Trachea and Thyroid #5

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Physical Examination
The Trachea and Thyroid #6

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Physical Examination
The Trachea and Thyroid #7

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Physical Examination
The Carotid Arteries and Jugular Veins
v Defer detailed examination until patient is lying down
v Jugular venous distention
o May be visible in sitting position
v Be alert to unusually prominent arterial pulsations

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Recording Findings
v Head
o Describe skull and hair.
v Neck
o Describe trachea, neck, and thyroid gland.
v Lymph nodes
o Note whether presence and location of any
adenopathy, tenderness, and movement.

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Question #3
v When recording the findings of the lymph glands, a nurse
should note all except:
A. Size
B. Shape
C. Consistency
D. Color

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Answer to Question #3
v When recording the findings of the lymph glands, a nurse
should note all except:
v D. Color
v When recording the examination, note the size, shape,
and consistency of the gland and identify any nodules or
tenderness.

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Health Promotion and Counseling #1
v Prevention of traumatic brain injury
v Leading causes
o Falls
o Motor vehicle accidents
o Being hit or struck by an object

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Health Promotion and Counseling #2
v Suggestions to decrease likelihood of falls:
o Install safety features
o Avoid use of throw rugs
o Remove extensive cords in high traffic areas
o Use rails on stairs
o Wear nonslip, well-fitting shoes

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Health Promotion and Counseling #3
v Suggestions to decrease likelihood of falls:
o Install gates on stairs
o Install window guards
o Do not use walkers for babies
o Review medication list with health care provider

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Health Promotion and Counseling #4
v Suggestions to prevent head injuries in motor vehicles
o Use seat belts
o Use car seats or booster seats with children
o Small children should sit in back seat, especially if
there is an airbag in front passenger seat
o Never drive under the influence of alcohol or drugs
o Wear helmet when appropriate (motorcycles, ATV,
snowmobiles, etc.)
o No texting when driving

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Health Promotion and Counseling #5
v Suggestions to avert injuries from objects
o Wear helmets when appropriate (sports)
o Place heavy objects on shelves at eye level or lower
o Avoid dangerous situations or fights
o Lock firearms and store bullets in separate area

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Question #4
v Prevention is the best policy for treating traumatic brain
injuries (TBI). The age group with the highest incidents
of TBI related to falls are:
A. Children, age 0 to 4
B. Adolescents, age 15 to 19
C. Adults, age 65 and older
D. Older adults, age 75 and older

Copyright © 2018 Wolters Kluwer · All Rights Reserved

Answer to Question #4
v Prevention is the best policy for treating traumatic brain
injuries (TBI). The age group with the highest incidents
of TBI related to falls are :
v C. Older adults, age 65 and older
v The CDC notes the age groups at highest risk for TBI
related to falls is the adults over the age of 65 with 81%
of incidents being in this age group. The second highest
group is the 0- to 14-year-old age group at 55% of TBIs
caused by falls.

Copyright © 2018 Wolters Kluwer · All Rights Reserved